JCPSLP Vol 17 No 3 2015

supported problem-solving, decisions, and outcomes. These elements describe the phases of ethical reasoning frequently used by speech pathologists with less than 18 months experience, in an interactive reasoning process rather than stages of discrete steps The initial stage of awareness was gradual – GG became gradually more aware of the ethical issues involved in the case, rather than a critical incident being the trigger. From this point she moved between the elements of independent and supported problem-solving. Her initial reaction was that the situation was “unjust”. This was followed by GG drawing on her clinical reasoning based on documenting communication information about the client’s performance, and her beliefs and values drawing on the SPA Code of Ethics. As a student on placement, she had a clinical educator who was in the position to support her problem-solving through discussion and creation of a plan to document the abilities that were not easily demonstrated. Supported problem-solving drew on the checking and discussing features of this element of the model (Kenny et al. 2007). This stage of supported problem-solving and encouragement may not always be in place for new graduates and can be crucial in developing the skills and confidence for independent ethical problem- solving in the future. The decision-making element in this case was the acceptance of the client for rehabilitation as a result of the advocacy by the student clinician and her clinical educator. Her evaluation of the final outcome allowed her to reflect back on the process involved and the role she played as an advocate for her client. In this clinical ethical reflection, it is clear how GG has learned skills in client management beyond a narrow “clinical” view. A further exploration of this scenario could also draw on the “ethics of care” approach documented in the SPA Ethics Training Package (Leitão et al., 2014). An ethics of care approach may be adopted by following guiding questions that prompt us to carefully consider key relationships involved in a dilemma. The following broad questions are suggested to support the process of analysis of a case with more focused questions underlying each: What are the needs of the individual and family affected by this dilemma? What are the roles and responsibilities of the health care team in providing care? Are there any barriers to effective care? What resources are required to provide competent health care? How are clients responding to care? How can I improve the care offered to clients? (Leitão et al., 2014, p.75) In this case, the ethics of care framework may support consideration of the needs of the client who is disempowered by the current situation and hence the advocacy role taken by the student clinician and her clinical educator. A newly graduated speech pathologist JC As a new grad speech pathologist, I am currently more reliant on my theoretical knowledge than my clinical experiences when making decisions. I was lucky enough that my theoretical education included a unit devoted purely to ethics. The content of these classes and the discussions about ethics that they generated is something that has directly impacted my day-to- day practice. This education in ethics has taught

me how to recognise an ethical problem, which is something that may come naturally for someone who has worked clinically for years. While I don’t map it out step by step, a general understanding of the Brown and Lamont (2002) ethical decision-making protocol (reprinted in the Leitão et al., 2014) has allowed me to recognise the issue and take the first steps to resolving it when something doesn’t feel quite right. The ethical problems I have encountered since graduating have not been huge dilemmas. However on reflection, I make decisions containing ethical issues very often, and rely on my theoretical learning to do so. An example of these has included [deciding] what to do when a family openly reports that they are not doing home practice, and constantly miss sessions. Another example was when a client’s mother wanted to trial her daughter on a high-tech AAC device she had purchased after reading about it on the Internet (her daughter continues to astound me with her ability to use this machine). The most comforting thing for me as a new graduate, and therefore at least somewhat unsure on every decision I make, is that I am not making them alone. Referring to the SPA Code of Ethics allows me to use it as a bit of a moral compass that covers areas my gut feelings don’t cover, and justifies the areas it did. I am also fortunate to work in a very supportive environment where I can access wonderful advice from a number of experienced speech pathologists. The explicit inclusion of ethical practice in my course has very much impacted the speech pathologist I am, and the speech pathologist I hope to still become. Suze Leitão and Trish Johnson – ethical reflections On reading this reflection we were struck by the fact that the newly graduated speech pathologist identified that she was still building up her “case-based” experience. In other words, JC is describing the idea that as we gain experience, we learn from the cases we have managed: both the ones that work out well but also those that don’t. In the SPA Ethics Training Package (Leitão et al., 2014), this relates to the chapter on “casuistry” – a perspective where clinicians draw on their own experience or documented cases to help solve current ethical problems or dilemmas. By considering the most important issues in a current scenario (e.g., not doing home practice and missing sessions), the clinician can try to flesh out what the current dilemma might be (e.g., not adhering to evidence-based guidelines for treatment, the client failing to make progress, another client missing out on access to appointments). The clinician can also consider if she or he has managed a similar case before and reflect on what the outcome was at that time. The approach taken, the evidence drawn upon, the outcome and – of course – the similarity to the current case, may be helpful in making a plan for this scenario. If, as is often the case with new graduates, a similar case is not yet in their repertoire, turning to the published literature or a more experienced colleague, may also be of help. In this scenario, the graduate clinician may then draw on a previous case perhaps leading to a phone call at a convenient time to listen to the mother’s story, explore barriers to attendance and home practice, and perhaps put in place other strategies, such as a different time for the session or training an older sibling to carry out some of the home practice.

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JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology